The criminalisation of people with mental health issues like BPD by the SIM model, which has already been adopted by half of the NHS, is a crime itself and must be stopped, writes Lucette Davies

May is Borderline Personality Disorder month which aims to raise awareness of this poorly understood diagnosis. But raising awareness of the fact mental health trusts are willingly adopting a plan to criminalise people suffering from this condition has to be a priority.

The book Sedated by James Davies exposes how mental health services are medicalising distress which is then ‘treated’ with medication. Davies provides evidence to show that psychotropic drugs have the effect of making a person less likely to recover. This is a shocking and immoral scandal but not anywhere near as immoral as the treatment of people who the psychiatric system has always accepted can’t be helped by drugs.

Personality disorders, of which ten have been identified, are not described as illnesses. There are no claims made about ‘chemical imbalances’, and hospitalisation is often considered to be harmful. The most common of these disorders is known as Borderline Personality Disorder (BPD). Around 20% of inpatients in psychiatric hospitals are recognised as having BPD as are 10-30% of outpatients. 

Patients with BPD are also likely to place a high demand on other services and general medicine. They are deeply stigmatised, labelled as attention seeking, manipulative and incurable. And that is by the people who are supposed to be there to help.

Therapeutic settings have existed and various models of therapy suggested to help the largely female population of BPD patients. But the uncomfortable reality for those who hold purse strings is that it is hard to find a means of anyone making profit from the treatment of personality disorders.

And then along came ex-police Sgt Paul Jennings who, along with his wife, has set up a private limited company known as the High Intensity Network (HIN).  HIN now runs a model of care known as Serenity Integrated Mentoring (SIM) aimed at people who place a high demand on services, such as BPD patients. This model uses police officers who are trained as High Intensity Officers (HIOs) to work with people who regularly access emergency services to reduce their demand on these services. 

These HIOs have full access to a patient’s medical records and can share police records with medical staff. They are given an initial three days of training led by Paul Jennings (who is not a mental health professional) and are not required to have any understanding of mental health service provision.

They aim to ‘teach’ the people who regularly self-harm or attempt suicide, for example, how not to use services. It goes back to the judgemental and stigmatising attitudes that label individuals who self-harm as ‘attention seeking’.

The techniques used by HIOs are coercive and aimed at forcing people to stop demonstrating intensive patterns of demand. They can instruct A&E units, 999 services, police and mental health services to refuse to respond to calls for assistance even if this call concerned a physical health condition. The theory is that if services respond when a patient asks for help they will ‘positively reinforce’ demanding behaviour.

It is a very patriarchal system of rigid ‘discipline’ to ‘teach’ people not to need help. Just as when medications are prescribed that make a person’s recovery less likely, this SIM model ignores the real reasons for distress. HIOs can even use Community Behaviour Orders to try and force a person’s behaviour to change, which potentially if breached could lead to five years in prison.

So it seems, when people, suffering from intense and unmanageable emotional distress, cannot be used to boost profits for pharmaceutical companies they are now criminalised. SIM is already being employed in 23 out of 52 NHS trusts and it seems likely to expand as more trusts adopt the model.

To tell a person whose life is chaotic, painful, unmanageable and terrifying that they are simply ‘attention seeking’ or ‘manipulative’ is abusive. To tell them that they are incurable is counter-productive. But to criminalise their distress should be considered as nothing more than criminal itself. If only people could understand what conditions like BPD are really about. That it is curable and people must not be denigrated for having the diagnosis.

In my home town, a small inpatient unit for six women existed until 2013 when Sussex Partnership closed it down. It was a hospital run along the lines of a therapeutic community and was the treatment provided when everything else had failed for women with complex and enduring mental health conditions. Many of the women who went there had already lost a lot of trust in services through the way they had been treated previously. It made the work of this unit much harder.  But the unit did improve many lives and it was a travesty when it closed.

Nothing was offered as a replacement service for a number of years. But the last time I saw a good friend of mine she told me that Sussex Partnership had been talking about starting a community project for people with personality disorders for a long time. I asked her if she felt that it would be helpful to her if it was set up. She replied with one word: ‘yes’. Sadly, I hadn’t realised how much she was struggling but a couple of weeks later she had killed herself.

I will never forgive Sussex Partnership for what they have done to women, like my friend, with BPD. It is said that between 1% and 4% of the population have BPD and 10% – 12% of those will die from it. That means there could be between one and four thousand people with BPD in this town. And if 10% of them will die from the condition that is 100-400 unnecessary deaths. BPD can be treated successfully, but not if we criminalise a person’s suffering. The SIM model of care has to stop.

A coalition of service users have set up a website to stop SIM. They have started a petition and are calling on people to write to their MP about it. This is what they are saying about the model:

• We believe that SIM breaches the Human Rights Act 1998. SIM’s policy on withholding potentially life-saving care from patients, breaches Article 2, relating to the Right to Life.
• We believe that SIM breaches the Equality Act 2010. SIM discriminates against people on the grounds of disability, gender, race, gender reassignment and sexuality.
• We believe that SIM breaches UK GDPR regulations. SIM allows ‘sensitive data’ to be shared between services without the subject’s consent.
• We believe that service users under the SIM model are suffering institutional abuse.
• We believe SIM will disproportionally impact people from minority and racialized communities. It is likely to act as an additional barrier to asking for help.
• There is no reliable evidence that SIM helps people. SIM’s outcome measures are all in terms of reduction of demand on services not increased wellbeing.
• Usually when new treatments are introduced into the NHS there is a careful process of checking it is safe and effective. SIM bypassed this process by being sold as an ‘innovation or quality improvement’.
• SIM states that most people under SIM have a diagnosis of BPD and a history of sexual abuse and violence. People with BPD are already highly stigmatised and discriminated against even within mental health services. We believe adding police into their care teams will only increase stigmatisation and cause further trauma to people who are already suffering from post-traumatic symptoms
• The SIM model has no meaningful patient, carer or public involvement in its development or delivery
• The SIM model criminalises people for their mental distress and does nothing about their unmet need for support